In-line intravenous filtration removes microparticles, air, and microorganisms from infusion solutions and has previously been associated with lower rates of systemic inflammatory response syndrome (SIRS) and complications in pediatric surgical populations. A triple-blind randomized controlled trial presented at the AATS 2026 meeting evaluated whether this strategy improves postoperative outcomes in adults undergoing cardiac surgery.

Adults undergoing elective coronary artery bypass grafting and/or valve surgery were randomized 1:1 to receive either in-line intravenous filtration for all perioperative infusions or standard intravenous therapy without filtration. The primary endpoint was SIRS within 96 hours after surgery. Secondary outcomes included organ dysfunction defined by Sepsis-3 criteria, Sequential Organ Failure Assessment (SOFA) scores, and major postoperative complications. A total of 474 patients were analyzed, including 231 assigned to in-line filtration and 243 to standard intravenous therapy.

Findings

• The incidence of SIRS within 96 hours after surgery did not significantly differ between the filtration and control groups (77.5% vs 83.5%; p=0.096).
• Organ dysfunction rates were similar between groups (15.6% vs 16.9%; p=0.704), and no significant differences were observed in SOFA scores over time.
• Major postoperative complications and mortality were comparable between treatment strategies.
• Mixed-effects regression analysis showed a significant time-dependent decline in SIRS severity during postoperative follow-up (−0.55 per 24 hours; 95% CI −0.69 to −0.40; p<0.001).
• In-line intravenous filtration had no independent effect on SIRS risk (−0.01; 95% CI −0.18 to 0.16; p=0.900), while younger age and diabetes mellitus were independently associated with higher SIRS risk.

The trial showed no measurable postoperative benefit of in-line intravenous filtration in adults undergoing cardiac surgery, despite reductions in SIRS and complications previously reported in pediatric populations